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  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
  • A61K31/4025—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil not condensed and containing further heterocyclic rings, e.g. cromakalim
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
  • A61K31/4245—Oxadiazoles
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  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
  • A61P1/16—Drugs for disorders of the alimentary tract or the digestive system for liver or gallbladder disorders, e.g. hepatoprotective agents, cholagogues, litholytics
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D405/00—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom
  • C07D405/02—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom containing two hetero rings
  • C07D405/06—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom containing two hetero rings linked by a carbon chain containing only aliphatic carbon atoms
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00

Definitions

• the invention relates generally to the field of hepatology and inhibition of the synthesis of glucosphingolipids, such as, e.g., the ganglioside GM3, in the liver. More particularly, the invention relates to the use of inhibitors of glucosphingolipid synthesis for the treatment of fatty liver disease and associated conditions. In certain aspects, the invention relates to the use of inhibitors of glucosphingolipid synthesis, such as, e.g., inhibitors of glucosylceramide synthase, lactosylceramide synthase, and/or GM3 synthase, for the treatment of fatty liver disease, including associated conditions.
• inhibitors of glucosphingolipid synthesis such as, e.g., inhibitors of glucosylceramide synthase, lactosylceramide synthase, and/or GM3 synthase
• Fatty liver disease (FLD, also know as hepatosteatosis) is a prevalent liver condition that occurs when lipids accumulate in liver cells. The lipid accumulation causes cellular injury and sensitizes the liver to further injuries. The accumulated lipids may also impair hepatic microvascular circulation.
• FLD may arise from a number of sources, including excessive alcohol consumption and metabolic disorders, such as those associated with insulin resistance, obesity, and hypertension.
• Nonalcoholic fatty liver disease (NAFLD) may also result from metabolic disorders such as, e.g., galactosemia, glycogen storage diseases, homocystinuria, and tyrosemia, as well as dietary conditions such as malnutrition, total parenteral nutrition, starvation, and overnutrition.
• NAFLD is associated with jejunal bypass surgery.
• Other causes include exposure to certain chemicals such as, e.g., hydrocarbon solvents, and certain medications, such as, e.g., amiodarone, corticosteroids, estrogens (e.g., synthetic estrogens), tamoxifen, maleate, methotrexate, nucleoside analogs, and perhexiline.
• certain medications such as, e.g., amiodarone, corticosteroids, estrogens (e.g., synthetic estrogens), tamoxifen, maleate, methotrexate, nucleoside analogs, and perhexiline.
• Acute fatty liver conditions can also arise during pregnancy.
• FLD is a prevalent condition.
• NAFLD alone has been estimated to affect as much as 25-33% of the adult population in the developed world. See, e.g., Cortez-Pinto et al., J. Am. Med. Assoc. 282:1659-1664 (1999); Adams et al., Can. Med. Assoc. J. 172:899-905 (2005); and Clark et al., J. Am. Med. Assoc. 289:3000- 3004 (2003). Moreover, NAFLD is also believed to affect as many as 3-10% of obese children.
• FLD can progress to more advanced liver disease such as nonalcoholic steatohepatitis (NASH; metabolic steatohepatitis), a condition characterized by liver inflammation and damage, often accompanied by fibrosis or cirrhosis of the liver. NASH may progress to further liver damage ultimately leading to chronic liver failure and, in some cases, hepatocellular carcinoma.
• NASH nonalcoholic steatohepatitis
• NASH has a prevalence of up to 9% of the general population. See, e.g., Cortez-Pinto et al., J. Am. Med. Assoc. 282:1659-1664 (1999). NASH patients have an increased incidence of liver-related mortality. Adams et al., Can. Med. Assoc. J. 172:899-905 (2005). About 640,000 adults in the U.S. are estimated to have cirrhosis resulting from NAFLD. Clark et al., J. Am. Med. Assoc. 289:3000- 3004 (2003). This number may underestimate the actual incidence, as undetected NAFLD is believed to be an important cause of cryptogenic liver cirrhosis. See, e.g., Clark et al., J. Am. Med. Assoc. 289:3000-3004 (2003) and Adams et al., Can. Med. Assoc. J. 172:899-905 (2005).
• the present invention provides methods of treating FLD in a mammal (such as, e.g., a human) in need of treatment by inhibiting glucosphingolipid synthesis in the mammal.
• a mammal such as, e.g., a human
• the mammal is diagnosed with nonalcoholic steatohepatitis, hepatic fibrosis, or hepatic cirrhosis, and/or is at risk for developing fatty liver disease.
• Glucosphingolipid (GSL) synthesis may be inhibited by inhibiting the enzymatic activity or expression of one or more GSL enzymes.
• treatment of the mammal results in a reduction in serum levels of at least one hepatic enzyme (such as, e.g., alanine aminotransferase, aspartate aminotransferase, ⁇ -glutamyltransferase, or alkaline phosphatase) and/or a decrease in hepatic lipid deposits.
• at least one hepatic enzyme such as, e.g., alanine aminotransferase, aspartate aminotransferase, ⁇ -glutamyltransferase, or alkaline phosphatase
• the glucosphingolipid whose synthesis is inhibited is chosen from, e.g., glucosylceramide, gangliosides, globo series glucosphingolipids, neolacto series glucosphingolipids, isoglobo series glucosphingolipids, and muco series glucosphingolipids.
• the glucosphingolipid whose synthesis is inhibited is the ganglioside GM3. Inhibition of GM3 can be achieved by inhibition of a GM3 synthesis enzyme chosen from glucosylceramide synthase, lactosylceramide synthase, and GM3 synthase.
• methods of the invention comprise administering to a subject having FLD or at risk for developing FLD a therapeutically effective amount of a composition comprising a glucosylceramide synthase inhibitor of Formula I:
• Ri is chosen from substituted and unsubstituted aryl, substituted and unsubstituted heteroaryl, and substituted or unsubstituted alkyl
• R 2 is chosen from substituted and unsubstituted alkyl
• R 3 is a substituted or unsubstituted tertiary cyclic amino.
• R 3 is not morpholino when R 1 is unsubstituted phenyl and R 2 is ⁇ -nonyl.
• Ri is a substituted or unsubstituted phenyl such as, e.g., 1 ,4-benzodioxan-6-yl.
• R 2 comprises at least 1 carbon atom, such as, e.g., CrC 2 , CrC 4 , CrCe, C 2 -Ci 0 , C 2 -C 2 O, C ⁇ -Cio, Cio- Cu, C 6 -Ci 4 , Ce-Cg, and C 7 -Ce saturated and unsaturated hydrocarbons.
• R 2 is substituted, e.g., by hydroxyl, alkoxy or aryloxy.
• R 2 is C 2 alkyl substituted by alkoxy or aryloxy.
• R 2 comprises at least 7 carbon atoms, such as, e.g., 7, 8, 9, or 10 carbon atoms.
• R 2 is chosen from substituted and unsubstituted C 7 alkyl, such as, e.g., 1-(1-hydroxyheptyl) and 1-(6-hydroxyheptyl), and from substituted and unsubstituted C 8 alkyl, such as, e.g., 1-(1-hydroxyoctyl) and 1-(7-hydroxyoctyl).
• R 3 is pyrrolidino.
• the compound of Formula I is a 1-(1 ,4-benzodioxan-6-yl)-2- nonanoylamino-3-pyrroiidino-i-propanol, such as, e.g., 1 (R)-(1 ,4-benzodioxan-6- yl)-2(R)-nonanoylamino- 3-pyrrolidino-1-propanol.
• the compound of Formula I is a 1-(1 ,4-benzodioxan-6-yl)-2-octanoylamino-3-pyrrolidino- 1-propanol, such as, e.g., 1 (R)-(1 ,4-benzodioxan-6-yl)-2(R)-octanoylamino- 3-pyrrolidino-1 -propanol.
• Figure 1 is a chart of the glycosphingolipid synthesis pathways.
• a wide bar indicates the synthetic step inhibited by inhibitors of glucosylceramide synthase.
• the following abbreviations are used: Cer, ceramide; GalCer, galactosylceramide; GlcCer, glucosylceramide; LacCer, laetosylceramide.
• the muco- and isoglobo- synthetic pathways are not depicted.
• FIGS 2A-2C are a series of photographs comparing hematoxylin and eosin stained liver sections of (A) diet-induced obese (DIO) C57BL/6 mice treated with water (control), (B) DIO mice treated with D-threo-1-(3',4'- ethylenedioxy)phenyl-2-octanoylamino-3-pyrrolidino-1-propanol (Formula Xl), and (C) lean mice treated with water (control). Mice were treated by daily oral gavage for 10 weeks and then sacrificed.
• Figure 1A large vacuoles are visible throughout the parenchyma of the livers from the water-treated control mice.
• Figure 1 B significantly fewer vacuoles are visible in the livers of mice treated with Formula Xl.
• the livers of normal, lean mice are devoid of any lipid-filled vacuoles.
• Figure 3 is a graph comparing the mean levels of liver triglycerides in DIO mice treated with water, DIO mice treated with 75 mg/kg Formula Xl, DIO mice treated with 125 mg/kg Formula Xl, and lean mice treated with water. Mice were treated by daily oral gavage for 16 weeks and then euthanized. The livers were harvested and homogenized. Triglyceride levels were measured in hepatic lipid extracts. A dose-dependent reduction in total triglyceride levels was observed upon treatment with Formula Xl.
• Figure 4 is a graph comparing the liver weight to body weight ratios of DIO mice treated with water, DIO mice treated with Formula Xl, and lean mice treated with water after 9 and 17 weeks of treatment. A reduction in the ratio of liver weight to body weight ratio was observed in DIO mice treated with Formula Xl for 9 and 17 weeks.
• FIGs 5A-5D are a series of graphs comparing the levels of liver enzymes in DIO mice treated with water and DIO mice treated with Formula Xl for 9 weeks.
• Figure 1 A lower levels of alanine aminotransferase (ALT) are observed in the drug-treated versus placebo-treated control animals.
• Figure 1 B lower levels of aspartate aminotransferase (AST) are observed in the drug-treated versus placebo-treated control animals.
• Figure 1C lower levels of alkaline phosphatase are observed in the drug-treated versus placebo-treated control animals.
• FIG 1 D lower levels of ⁇ -glutamyltransferase (GGT) are observed in the drug-treated versus placebo-treated control animals.
• GTT ⁇ -glutamyltransferase
• Figure 6 is a graph comparing the liver weight to body weight ratios of ob/ob mice treated with water, ob/ob mice treated with Formula X, and lean mice treated with water after 6 weeks of treatment. A reduction in the ratio of liver weight to body weight ratio was observed in ob/ob mice treated with Formula X for 6 weeks.
• Figures 7A-G are a series of graphs comparing the expression of hepatic genes involved in lipogenesis, gluconeogenesis, inflammation, and fibrosis in ob/ob mice treated with water, ob/ob mice treated with Formula X, and lean mice treated with water after 6 weeks of treatment.
• Figure 7A lower levels of sterol regulatory element binding protein 1c (SREBP-Ic) RNA are observed in the drug- treated versus placebo-treated control animals.
• SREBP-Ic sterol regulatory element binding protein 1c
• ACL1 acid citrate lyase 1
• Glycosphingolipids glycolipids composed of glycosylated ceramides, are found in plasma membrane, and are involved in a variety of physiological and pathogenic processes, such as cell-cell recognition, immunity, and tumor metastasis.
• Figure 1 is a chart depicting the pathways of glycosphingolipid synthesis from ceramide.
• Glucosphingolipids are glucose-containing glycosphingolipids, including GlcCer and glycosphingolipids derived from GlcCer.
• GM3 is a ganglioside composed of a ceramide molecule glycosylated with a monosialylated trisaccharide.
• Gangliosides such as GM3 are generally found in microdomains of the outer leaflet of the plasma membrane (Nojiri et al., Proc. Natl. Acad. ScI. U.S.A. 83:782-786 (1986)), where they are involved in cell signaling and act as modulators of receptor activity (Yamashita et al., Proc. Natl. Acad. ScL U.S.A. 100:3445-3449 (2003)).
• GM3 is synthesized in the cell by the stepwise enzymatic addition of activated sugar molecules to a ceramide molecule.
• the first step in the synthesis of GM3 is the addition of glucose to ceramide to form glucosylceramide (GlcCer; glucocerebroside). This step is catalyzed by the enzyme glucosylceramide synthase (UDP-glucose:ceramide glucosyltransferase; ceramide glucosyltransferase; GlcCer synthase; EC 2.4.1.80).
• a galactose moiety is added to form lactosylceramide.
• a sialic acid ⁇ /-acetylneuraminate
• GM3 synthase CMP- Neu Ac: lactosylceramide ⁇ 2,3-sialyltransferase; EC 2.4.99.9.
• the present invention is based, in part, on the discovery that inhibition of GlcCer synthesis reduces hepatic lipid deposits in a murine model for nonalcoholic fatty liver disease. Accordingly, reduction of downstream GSL (such as, e.g., GM3) levels is expected to be useful in the treatment of FLD. In certain aspects, reduction of GM3 levels, e.g., by inhibition of GlcCer synthase, LacCer synthase, or any of the enzymes involved in the synthesis of GM3, is expected to be useful in the treatment of FLD.
• GSL such as, e.g., GM3
• Methods of inhibiting GSL synthesis include inhibiting the expression and/or enzymatic activity of one or more GSL synthesis enzymes. In some embodiments, the methods include inhibiting the expression and/or enzymatic activity of at least 1 , 2, 3, 4, 5, or 6 GSL synthesis enzymes.
• a GSL synthesis enzyme is an enzyme that catalyzes any step of the synthesis of the following glucosphingolipids from ceramide: GlcCer, LacCer, GA2, GA1 , GM1b, GD1c, GD1 ⁇ , GM3, GM2, GM1a, GDIa 1 GT1a, GD3, GD2, GD1b, GT ⁇ b, GQ1 b, GT3, GT2, GT ⁇ c, GQ1c, GP1c, Gb3, Gb4, Lc3, paragloboside, NeuAc ( ⁇ -2,3) paragloboside, or NeuAc (cc-2,6) paragloboside.
• a GSL synthesis enzyme may be chosen from, e.g., GlcCer synthase (glucosylceramide synthase), LacCer synthase (lactosylceramide synthase), GA2 synthase, GA1 synthase, GM1 b synthase, GD1c synthase, GD1 ⁇ synthase, GM3 synthase, GM2 synthase ( ⁇ -1 ,4-/V-acetylgalactosaminyltransferase), GM1a synthase, GD1a synthase, GT1 a synthase, GD3 synthase, GD2 synthase, GD1 b synthase, GT1 b synthase, GQ1 b synthase, GT3 synthase, GT2 synthase, GT1c synthase, GQ1c synthase, GP1c synthase,
• each of the synthases above is understood to be the enzyme that catalyzes the final step of the synthesis of the respective glucosphingolipid.
• Gb3 synthase is understood to be the enzyme that catalyzes the final step of the synthesis of Gb3.
• the inhibition of a GSL synthesis enzyme's expression may be accomplished at a nucleic acid level, e.g., using antisense nucleic acids and small interfering RNAs (siRNAs).
• Antisense oligonucleotides are capable of hybridizing to a portion of a coding and/or noncoding region of mRNA by virtue of sequence complementarity, thereby interfering with translation from the mRNA.
• Antisense nucleic acids may be produced using standard techniques as described in Antisense Drug Technology: Principles, Strategies, and Applications, 1 st ed., Ed. Crooke, Marcel Dekker (2001).
• siRNAs are short (e.g., 20-25 nt) double stranded RNAs that inhibit an enzyme of interest via post-transcriptional gene silencing.
• a specific siRNA may be prepared and used as described in U.S. Patent No. 6,506,559 and/or using other suitable methods (see, e.g., Appasani (ed.) RNA Interference Technology: From Basic Science to Drug Development, Cambridge University Press, 1st ed., 2005; and Uei-Ti et al. Nucleic Acids Res., 32:936-948 (2004)).
• the inhibition of GSL synthesis is accomplished by administering to the mammal a molecule that inhibits the enzymatic activity (i.e., an inhibitor) of one or more GSL synthesis enzymes.
• a molecule that inhibits the enzymatic activity of a GSL synthesis enzyme may be an analog of the natural substrate of the inhibited GSL synthesis enzyme.
• Various types of molecules that inhibit enzymatic activity may be obtained by screening appropriate libraries such as, e.g., a small molecule library (Gordon et al., J. Med. Chem. 37:1385-1401 (1994); Ecker et al., BioTechnology 13:351-360 (1995); DoIIe, J.
• a phage display library of peptides which can be constrained peptides (see, e.g., U.S. Patent No. 5,622,699; U.S. Patent No. 5,206,347; Scott et al., Science 249:386-390 (1992); Markland et al., Gene 109:13-19 (1991); a peptide library (see, e.g., U.S. Patent No.
• a library of peptide derivative compounds such as a hydroxamate compound library, reverse hydroxamate compound library, a carboxylate compound library, thiol compound library, a phosphinic peptide library or phosphonate compound library (see, e.g., Dive et al., Biochem. Soc. Trans. 28:455-460 (2000); Ye et al., Peptides: The Wave of the Future (Lebl and Houghten, ed.; American Peptide Society, 2001); a peptidomimetic library (Blondelle et al., Trends Anal. Chem.
• Inhibitors of GSL synthesis enzymes used in the methods of the invention may be competitive or noncompetitive inhibitors.
• Competitive inhibitors include substrate analogs (including analogs of a portion of a substrate) which bind to the active site of the enzyme of interest and thereby prevent substrate binding.
• An inhibitor may inhibit an enzyme with an IC50 of, for example, less than 200, 150, 100, 75, 50, 40, 30, 20, 10, 5, 3, 2, or 1 ⁇ M.
• an inhibitor may inhibit an enzyme with an IC50 of less than 1 ⁇ M, such as, for example, less than 750, 500, 400, 300, 200, 100 nM.
• an inhibitor may inhibit an enzyme with an IC50 of, for example, less than 90, 80, 70, 60, 50, 40, 30, 20, 10, 9, 8, 7, 6, 5, 4, 3, 2, or 1 nM.
• Inhibitors of GSL synthesis enzymes used in the methods of the invention include, e.g., tamoxifen, mifepristone, imino sugars (such as, e.g., ⁇ /-butyldeoxynojirimycin and ⁇ /-buyldeoxygalactonojirimycin), "P-drugs” (such as, e.g., D,L-threo-1-phenyl-2-decanoylamino-3-morpholino-1-propanol (PDMP) and analogs thereof, (R,R)-(D-threo)1 -phenyl-2-decanoylamino-3-morpholino-1 -propanol, D-threo-4'-hydroxy-1 -phenyl-2-palmitoylamino-2-pyrrolidino-1 -propanol, D-threo-4'- hydroxy-1 -phenyl-2-palmitoylamino-2-pyrrolidino
• the inhibitor of giucosylceramide synthase is not PDMP.
• Inhibitors of GSL synthesis enzymes further include inhibitors of GM1 synthesis such as, e.g., tunicamycin.
• Inhibitors of GSL synthesis enzymes further include inhibitors of GM2 synthesis such as, e.g., tunicamycin. Yusuf et al., Proc. Natl. Acad. Sci. U.S.A. 80:7075-7079 (1983).
• Inhibitors of GSL synthesis enzymes also include inhibitors of GM3 synthesis including, e.g., antisense-type inhibitors (see, e.g., Deng et al., Glycobiology 12:145-152 (2002)). Inhibitors of GSL synthesis enzymes further include sialyltransf erase inhibitors such as, e.g., lithocholic acid analogues (see, e.g., Chang et al., Chem. Commun. 629-631 (2006)).
• the methods cause a decrease in the synthesis of at least one glucosphingolipid chosen from giucosylceramide, a ganglioside (such as, e.g., an a-series ganglioside, a b-series ganglioside, a c-series ganglioside, and an o-series ganglioside), a globo-series glucosphingolipid, a neolacto-series glucosphingolipid, an isoglobo-series glucosphingolipid, and a muco-series glucosphingolipid.
• the methods cause a decrease in the synthesis of an a-series ganglioside, such as, e.g., the ganglioside GM3.
• inhibition of GSL synthesis comprises inhibition of GM3 synthesis.
• Methods of inhibiting GM3 synthesis include inhibiting the expression and/or enzymatic activity of one or more GM3 synthesis enzymes, which include (a) giucosylceramide synthase, (b) lactosylceramide synthase, and (c) GM3 synthase.
• Inhibitors of giucosylceramide synthase include, e.g., substrate analogs which bind to the enzyme active site and prevent substrate binding. These inhibitors include ceramide analogs, as described in, e.g., U.S. Patent Nos. 6,569,889; 6,255,336; 5,916,911 ; 5,302,609; Lee et al., J. Biol. Chem. 274:14662-14669 (1999)) and sugar analogs, as described in, e.g., U.S. Patent Nos. 6,660,749; 6,610,703; 5,472,969; 5,525,616; and Overkleef et al., J. Biol. Chem. 273(41 ):26522-26527 (1998).
• the inhibitors may be analogs of a substrate or a portion of a substrate of glucosylceramide synthase, such as e.g., a ceramide analog or glycosylceramide analog.
• Suitable ceramide analogs include those described in U.S. Patent Nos. 6,569, 889; 6,255,366; 6,051 ,598, 5,916,911 ; lnokuchi et al., J. Lipid Res. 28:565 (1987); Shayman et al., J. Biol. Chem. 266:22968 (1991); and Bell et al., Ed., 1993, Advances in Lipid Research: Sphingolipids in Signaling (Academic Press, San Diego).
• the invention provides an inhibitor of glucosylceramide synthase that is a 2-amino-1-propanol ceramide analog of Formula I:
• R 1 , R 2 , and R 3 are set forth below.
• Such inhibitors may be prepared as described in, e.g., U.S. Patent No. 6,855,830.
• R 1 is chosen from substituted or unsubstituted aryl and substituted or unsubstituted heteroaryl.
• one or more hydrogen atoms of R 1 may be replaced by a suitable substituent such as, e.g., acyl, acylamino, acyloxy, alkenyl, alkoxy, alkyl, alkynyl, amido, amino (e.g., substituted or unsubstituted amino), aryl, aryioxy, azido, carbamoyl, carboalkoxy, carboxy, cyano, cycloalkyl, formyl, guanidino, halo, heteroaryl, heterocyclyl, hydroxy, iminoamino, nitro, oxo, phosphonamino, sulfinyl, sulfonamino, sulfonate, sulfonyl, thio, thioacylamin
• R 1 may be substituted phenyl, such as, e.g., phenyl substituted with hydroxy, alkoxy (such as, e.g., CrC 2 O. C1-C-10, C10-C20, C 3 -Ci 5 , or C 7 -Ci 2 alkoxy, including, e.g, ethoxy and methoxy), or halo (e.g., iodo, bromo, chloro, or fluoro).
• alkoxy such as, e.g., CrC 2 O. C1-C-10, C10-C20, C 3 -Ci 5 , or C 7 -Ci 2 alkoxy, including, e.g, ethoxy and methoxy
• halo e.g., iodo, bromo, chloro, or fluoro
• Ri is chosen from 2-hydroxyphenyl, 3-hydroxyphenyl, 4-hydroxyphenyl, 2-methoxyphenyl, 3-methoxyphenyl, 4-methoxyphenyl, 3,4-dimethoxyphenyl, 2-chlorophenyl, 3-chlorophenyl, 4-chlorophenyl, 2-fluorophenyl, 3-fluorophenyl, 4-fluorophenyl, 2-bromophenyl, 3-bromophenyl, 4-bromophenyl, 2-iodophenyl, 3-iodophenyl, or 4-iodophenyl.
• Ri is chosen from 2-(trifluoromethyl)phenyl, 3-(trifluoromethyl)phenyl, 4-(trifluoromethyl)phenyl, 2-(trifluoromethoxy)phenyl, and 3-(trifluoromethoxy)phenyl, 4-(trifluoromethoxy)phenyl.
• R 1 is chosen from phenyl fused with at least one aryl, cycloalkyl, or heterocyclyl ring.
• R 1 may be a phenyl ring fused with a 1 ,4-dioxane ring, i.e., 3,4-ethylenedioxyphenyl or 1 ,4-benzodioxanyl (Formula II).
• R-i may be 1 ,4-benzodioxan-6-yl (Formula Ha) or 1 ,4-benzodioxan-5-yl (Formula lib).
• Ri may be, e.g., 3,4-methylenedioxyphenyl (1 ,3-benzodioxolyl; Formula III) or 3,4-propylenedioxyphenyl (Formula IV).
• Ri is chosen from substituted or unsubstituted straight and branched alkyl, alkenyl, and alkynyl (saturated and unsaturated hydrocarbons).
• the saturated or unsaturated hydrocarbon may be, chosen from, e.g., C 2 -C 2O , C 2 -Ci 2 , C 2 -C 6 , C 3 -Ci 5 , and C 7 -Ci 2 saturated and unsaturated hydrocarbons.
• Ri is chosen from alkenyl groups such as, e.g., alk-1-en-1-yl groups.
• the 1-propanol group is an allylic alcohol.
• the compound of Formula I is an allylic alcohol in embodiments wherein Ri is, e.g., 1-pentenyl, 1-hexenyl, 1-heptenyl, 1-octenyl, 1-nonenyl, 1-decenyl, 1 -undecenyl, or 1-dodecenyl.
• Ri is, e.g., 1-pentenyl, 1-hexenyl, 1-heptenyl, 1-octenyl, 1-nonenyl, 1-decenyl, 1 -undecenyl, or 1-dodecenyl.
• the saturated or unsaturated hydrocarbon may be substituted by a suitable substituent such as, e.g., acyl, acylamino, acyloxy, alkenyl, alkoxy, alkyl, alkynyl, amido, amino (e.g., substituted or unsubstituted amino), aryl, aryloxy, azido, carbamoyl, carboalkoxy, carboxy, cyano, cycloalkyl, formyl, guanidino, halo, heteroaryi, heterocyclyl, hydroxy, iminoamino, nitro, oxo, phosphonamino, sulfinyl, sulfonamino, sulfonate, sulfonyl, thio, thioacylamino, thioureido, and ureido.
• a suitable substituent such as, e.g., acyl, acylamino,
• one or more methylene groups of the saturated or unsaturated hydrocarbon, or of a substituent thereof, may be substituted by a heteroatom such as, e.g., oxygen, nitrogen, or sulfur.
• the saturated or unsaturated hydrocarbon may be substituted with at least one hydroxyl group.
• the saturated or unsaturated hydrocarbon may be substituted with a hydroxyl group positioned 1 , 2, 3, 4, or 5 carbon atoms away from carbon 1 or carbon 2 of Formula I.
• R 2 is chosen from substituted or unsubstituted saturated and unsaturated hydrocarbons such as, e.g., Ci-C 2 , CrC 4 , d-C-6, C 2 -CiO, CrC 2 O, C ⁇ -Cio, Cio-Cu, C ⁇ -Cu, Ce-Cg, and C 7 -Ce saturated and unsaturated hydrocarbons.
• R 2 is chosen from substituted or unsubstituted C 5 , C 6 , C 7 , C 8 , and C 9 saturated and unsaturated hydrocarbons.
• R 2 is chosen from saturated and unsaturated hydrocarbons substituted with at least one substituent chosen from acyl, acylamino, acyloxy, alkenyl, alkoxy, alkyl, alkynyl, amido, amino (e.g., substituted or unsubstituted amino), aryl, aryloxy, azido, carbamoyl, carboalkoxy, carboxy, cyano, cycloalkyl, formyl, guanidino, halo, heteroaryi, heterocyclyl, hydroxy, iminoamino, nitro, oxo, phosphonamino, sulfinyl, sulfonamino, sulfonate, sulfonyl, thio, thioacylamino, thioureido, and ureido.
• substituent chosen from acyl, acylamino, acyloxy, alkenyl, alkoxy, al
• one or more methylene groups of R 2 may be substituted by a heteroatom such as, e.g., oxygen, nitrogen, or sulfur.
• R 2 may be a saturated or unsaturated hydrocarbon substituted with at least one hydroxyl, alkoxy, or aryloxy group, such as a CrC 2 , CrC 4 , CrC ⁇ , C 2 -CiO, CrC 2 O, C-6-C10, Cio-Cu, Ce-Ci 4 , C ⁇ -Cg, and C 7 -Cs saturated or unsaturated hydrocarbon substituted with at least one hydroxyl, alkoxy, or aryloxy group, where the alkoxy or aryloxy group may be substituted.
• the alkoxy or aryloxy group may be substituted by at least one substituent chosen from acyl, acylamino, acyloxy, alkenyl, alkoxy, alkyl, alkynyl, amido, amino (e.g., substituted or unsubstituted amino), aryl, aryloxy, azido, carbamoyl, carboalkoxy, carboxy, cyano, cycloalkyl, formyl, guanidino, haio, heteroaryl, heterocyclyl, hydroxy, iminoamino, nitro, oxo, phosphonamino, sulfinyl, sulfonamino, sulfonate, sulfonyl, thio, thioacylamino, thioureido, and ureido.
• substituent chosen from acyl, acylamino, acyloxy, alkenyl, alkoxy, alky
• R 2 is 1-heptyl
• the 1-heptyl may be substituted at, e.g., position 1 and/or 6, and in embodiments wherein R 2 is 1-octyl, the 1-octyl may be substituted at, e.g., position 1 and/or 7.
• R 2 may be 1-(1-hydroxyheptyl) (Formula V), 1-(6-hydroxyheptyl) (Formula Vl), 1-(1-hydroxyoctyl) (Formula VII), or 1-(7-hydroxyoctyl) (Formula VIII).
• R 2 is C 2 -Ci 0 alkyl substituted by optionally substituted alkoxy or aryloxy.
• R 2 is C 2 -C 4 alkyl substituted by optionally substituted alkoxy or aryloxy.
• R 2 is C 2 alkyl substituted by aryloxy such as 4-methoxyphenoxy.
• R 3 is substituted or unsubstituted amino such as, e.g., secondary or tertiary amino.
• R 3 has the structure of Formula IX below, where a wavy line indicates the point of attachment of the amino group.
• Ri 8 and Ri 9 may each be independently selected from, e.g., hydrogen, acyl, acyloxy, alkenyl, alkoxy, alkyl, alkynyl, aryl, aryloxy, carbamoyl, carboalkoxy, carboxy, cycloalkyl, formyl, heteroaryl, heterocyclyl, hydroxy, imino, nitro, OXO, sulfinyl, sulfonyl, and thio.
• R i8 and Ri 9 may be substituted with at least one substituent chosen from acylamino, acyloxy, alkenyl, alkoxy, alkyl, alkynyl, amido, amino, aryl, aryloxy, azido, carbamoyl, carboalkoxy, carboxy, cyano, cycloalkyl, disubstituted amino, formyl, guanidino, halo, heteroaryl, heterocyclyl, hydroxy, iminoamino, monosubstituted amino, nitro, oxo, phosphonamino, sulfinyl, sulfonamino, sulfonate, sulfonyl, thio, thioacylamino, thioureido, and ureido.
• one or more methylene groups of Ri 8 , Ri 9 , or a substituent thereof may be substituted by a
• R 3 has the structure of Formula IX, where R 18 and Rig are taken together with N to form a heterocyclyl (i.e., R 3 is a tertiary cyclic amino).
• the heterocyclyl may be substituted or unsubstituted by, e.g., at least one substituent independently selected from acyl, alkyl, alkenyl, alkenoxy, alkynyl, aldehyde, alkoxy, amido, amino, aryl, aryloxy, carboxy, cyano, cycloalkyl, ether, ester, halogen, heteroaryl, heterocyclyl, hydroxy, keto, nitro, oxo, perfluoroalkyl, sulfonyl, sulfonate, and thio.
• one or more methylene groups of the heterocyclyl, or a substituent thereof may be substituted by a heteroatom such as, e.g., oxygen, nitrogen, or sulfur.
• the heterocyclyi is, e.g., pyrrolidino, azetidino, piperidino, piperazino, morpholino, thiomorpholino, or hexamethyleneimino.
• the heterocyclyi is not morpholino.
• R 3 is not morpholino when R 1 is unsubstituted phenyl and R 2 is n-nonyl. In certain embodiments, R 3 is not morpholino, irrespective of all other groups.
• the glucosylceramide synthase inhibitor is 1-(1 ,4-benzodioxan-6-yl)-2-nonanoylamino-3-pyrrolidino-1-propanol (Formula X), or a salt thereof.
• the glucosylceramide synthase inhibitor may be 1 (R)-(1 ,4-benzodioxan-6-yl)-2(R)-nonanoylamino-3-pyrrolidino-1 -propanol, 1 (R)-(1 ,4-benzodioxan-6-yl)-2(S)-nonanoylamino-3-pyrrolidino-1 -propanol, 1 (S)-(1 ,4-benzodioxan-6-yl)-2(R)-nonanoylamino-3-pyrrolidino-1 -propanol, or 1 (S)-(1 ,4-benzodioxan-6-yl)-2(S)-nonanoylamino-3-pyrrolidino-1 -propanol.
• the glucosylceramide synthase inhibitor is 1 (R)-(1 ,4-benzodioxan-6-yl)-2(R)-nonanoylamino-3-pyrrolidino-1 -propanol (i.e., D-ffrreo-1 -(1 ,4-benzodioxan-6-yl)-2(R)-nonanoylamino-3-pyrroiidino-1 -propanol).
• the glucosylceramide synthase inhibitor is 1-(1 ,4-benzodioxan-6-yl)-2-octanoylamino-3-pyrrolidino-1 -propanol (Formula Xl), or a salt thereof.
• the glucosylceramide synthase inhibitor may be 1 (R)-(1 ,4-benzodioxan-6-yl)-2(R)-octanoylamino-3-pyrrolidino-1 -propanol, 1 (R)-(1 ,4-benzodioxan-6-yl)-2(S)-octanoylamino-3-pyrrolidino-1 -propanol, 1 (S)-(1 ,4-benzodioxan-6-yl)-2(R)-octanoylamino-3-pyrrolidino-1 -propanol, or 1 (S)-(1 ,4-benzodioxan-6-yl)-2(S)-octanoylamino-3-pyrrolidino-1 -propanol.
• the glucosylceramide synthase inhibitor is 1 (R)-(1 ,4-benzodioxan-6-yl)-2(R)-octanoylamino-3-pyrrolidino-1 -propanol (i.e., O-threo- ⁇ -(1 ,4-benzodioxan-6-yl)-2-octanoylamino-3-pyrrolidino-1 -propanol).
• the glucosylceramide synthase inhibitor is 1 -(1 ,4-benzodioxan-6-yl)-2-(4-methoxyphenoxy)propanoylamino-3-pyrrolidino-1 - propanol (Formula XII), or a salt thereof.
• the glucosylceramide synthase inhibitor may be 1 (R)-(1 ,4-benzodioxan-6-yl)-2(R)-(4-methoxyphenoxy)propanoylamino-3-pyrrolidino- 1 -propanol, 1 (R)-(1 ,4-benzodioxan-6-yl)-2(S)-(4-methoxyphenoxy)propanoylamino- 3-pyrrolidino-1 -propanol, 1 (S)-(1 ,4-benzodioxan-6-yl)-2(R)- (4-methoxyphenoxy)propanoylamino-3-pyrrolidino-1 -propanol, or 1 (S)-(1 , 4-benzodioxan-6-yl)-2(S)-(4-methoxyphenoxy)propanoylamino-3-pyrrolidino- 1 -propanol, or 1 (
• the glucosylceramide synthase inhibitor is 1 (R)-(1 , 4-benzodioxan-6-yl)-2(R)-(4-methoxyphenoxy)propanoylamino-3-pyrrolidino- 1 -propanol (i.e., D-f/?reo-1-(1 ,4-benzodioxan-6-yI)-2(R)- (4-methoxyphenoxy)propanoylamino-3-pyrrolidino-1 -propanol).
• the compounds of Formula I specifically inhibit glucosylceramide synthase relative to another GSL synthesis enzyme.
• a compound of Formula I may inhibit glucosylceramide synthase at least, e.g., 2, 3, 4, 5, 10, 15, 20, 100, or 1000-fold more effectively than GM3 synthase or lactosylceramide synthase.
• the compounds of Formula I may inhibit at least one other GSL synthesis enzyme.
• the compounds of Formula I may be tested for the ability to inhibit glucosylceramide synthase.
• Assays for glucosylceramide synthase activity are described in, e.g., U.S. Patent Appl. No. 2004/0097551 A1 ; Platt et al., J. Biol. Chem. 269:27108-27114 (1994); Gouaze et al., MoI. Cancer Ther. 3:633-640 (2004); Chujor et al., J. Lipid Res. 39:277-285 (1998); Shayman et al., Meth. Enzymol. 311 :42-9 (2000); and Hayashi et al., Anal. Biochem. 345:181-186 (2005).
• Inhibitors of lactosylceramide synthase include, e.g., antisense oligonucleotides, siRNAs, and inhibitory molecules chosen from, e.g., small molecules, oligosaccharides, carbohydrate mimetics, glycoproteins, glycolipids, lipoproteins, peptides, peptide derivatives, peptidomimetics, and nucleic acids.
• the inhibitor of lactosylceramide synthase is gluco-4-epoxy-4-C-methyleneglycosyceramide (see, e.g., Zacharias et al., J. Biol. Chem. 269:13313-13317 (1994)).
• Inhibition of lactosylceramide activity may assessed by any suitable assay, such as, e.g., the assay described in Hayashi et al., Anal. Biochem. 345:181-186 (2005).
• Inhibitors of GM3 synthase include, e.g., antisense oligonucleotides, siRNAs, and inhibitory molecules chosen from, e.g., small molecules, oligosaccharides, carbohydrate mimetics, glycoproteins, glycolipids, lipoproteins, peptides, peptide derivatives, peptidomimetics, and nucleic acids.
• GM3 synthase include, e.g., those described in International Patent Appl. Pub. No. WO 2005/108600.
• the inhibitor of GM3 synthase is a carbon-linked analog of cytidine monophospho- ⁇ /-acetylneuraminic acid (CMP-NANA), as described in Hatanaka et al., Heterocycles 43:531 -534 (1996).
• CMP-NANA cytidine monophospho- ⁇ /-acetylneuraminic acid
• Inhibition of GM3 synthase activity may assessed by any suitable assay, such as, e.g., the assays described in International Patent Appl. Pub. No. WO 2005/108600, International Patent Appl. Pub. No.
• the invention provides methods of treating FLD by inhibition of GSL synthesis.
• the invention provides methods of treating FLD by inhibition of GSL synthesis.
• inhibition of GSL synthesis may be inhibition of GM3 synthesis. These methods may include (a) identifying a mammal in need of the treatment and (b) administering to the mammal a composition that inhibits GSL synthesis, thereby treating FLD.
• treat and its cognates refer to delaying the onset, slowing the progression, or reducing the severity of a disease and associated conditions or symptoms and does not require a complete cure of a disease.
• fatty liver disease refers to a disease or a pathological condition caused by, at least in part, abnormal hepatic lipid deposits.
• Fatty liver disease includes, e.g., alcoholic fatty liver disease, nonalcoholic fatty liver disease, and acute fatty liver of pregnancy.
• Fatty liver disease may be, e.g., macrovesicular steatosis or microvesicular steatosis.
• a mammal in need of treatment may be one who is at increased risk of developing FLD.
• NAFLD has also been associated with rapid weight loss
• patients treated with certain medications such as, e.g., amiodarone, corticosteroids, estrogens (e.g., synthetic estrogens), maleate, methotrexate, perhexiline, salicylate, tamoxifen, tetracyclcine, and valproic acid may have, or be at increased risk of developing, a disorder associated with hepatic lipid deposits.
• certain medications such as, e.g., amiodarone, corticosteroids, estrogens (e.g., synthetic estrogens), maleate, methotrexate, perhexiline, salicylate, tamoxifen, tetracyclcine, and valproic acid may have, or be at increased risk of developing, a disorder associated with hepatic lipid deposits.
• a subject in need of treatment may be presumptively diagnosed on the basis of symptoms.
• steatosis particularly macrovesicular steatosis (in which hepatocytes are filled with large lipid droplets which displace the nuclei to the periphery)
• macrovesicular steatosis in which hepatocytes are filled with large lipid droplets which displace the nuclei to the periphery
• Alcohol-related fatty liver disease in general, is often asymptomatic.
• Microvesicular steatosis in which hepatocytes are filled with small lipid droplets, and nuclei are centrally located
• NAFLD may also be more likely to be symptomatic in children. Carey et al., eds., 1998, The Washington Manual of Medical Therapeutics, 29 th ed. (Lippincott Williams & Williams, Philadelphia).
• Symptoms of a disorder associated with hepatic lipid deposits when present, may be valuable in establishing a presumptive diagnosis.
• Such symptoms include, e.g., abdominal discomfort (e.g., discomfort in the right upper abdominal quadrant), acanthosis nigricans, bowel dismotility, coma, constipation, disseminated intravascular coagulopathy, epigastric pain, fatigue, hepatomegaly (generally with a smooth, firm surface upon palpation), hypoglycemia, jaundice, lipomatosis, lipoatrophy, lipodystrophy, nausea, neurological defects, Palmer erythema, panniculitis, periumbilical pain, small bowel bacterial overgrowth, spider angiomata, splenomegaly, subacute liver failure, and vomiting.
• abdominal discomfort e.g., discomfort in the right upper abdominal quadrant
• acanthosis nigricans e.g., acanthosis nigricans
• a subject in need of treatment may also be presumptively diagnosed by serum tests of liver enzymes.
• steatosis may be indicated by elevated serum levels (often moderately elevated, e.g., elevated approximately 2, 3, 4, 5, 6, 7, 9, 10, 11 , or 12-fold above normal levels) of liver enzymes (such as, e.g., alanine aminotransferase, aspartate aminotransferase, ⁇ -glutamyltransferase, alkaline phosphatase) when other causes (such as, e.g., acute hepatitis, autoimmune disease, chronic hepatitis, cirrhosis, fulminant hepatitis, hepatocellular carcinoma, metastatic carcinoma, right heart failure, and viral hepatitis) have been eliminated.
• liver enzymes such as, e.g., alanine aminotransferase, aspartate aminotransferase, ⁇ -glutamyltransferase, alkaline
• alanine aminotransferase (ALT or SGPT) values greater than 32, 24, or 56 units per liter of serum or at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 , 12, or more times normal values may be indicative of a disorder associated with hepatic lipid deposits, or by aspartate aminotransferase (AST or SGOT) values greater than 40 units per liter of serum or at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 , 12, or more times normal values.
• the ratio of AST to ALT is often less than one in NAFLD, but may be greater than one in patients with alcoholic liver disease or advanced liver disease.
• ⁇ -glutamyltransferase levels may be significantly elevated, e.g., at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 , 12, or more times normal values.
• the mean corpuscular volume (MPV) may be greater than, e.g., 86, 98, 100, or 110 femtoliters.
• a subject in need of treatment may also be presumptively diagnosed by noninvasive imaging techniques (e.g., ultrasonography, computed tomography, and magnetic resonance imaging) when steatosis is greater than, e.g., 25% or 30%.
• noninvasive imaging techniques e.g., ultrasonography, computed tomography, and magnetic resonance imaging
• NAFLD may present as a focal or diffuse accumulation of lipid, but in NASH the lipid is generally diffuse.
• NAFLD may also be detected by magnetic resonance spectroscopy, a technique which may be of value for quantitative determination of hepatic lipid levels.
• a subject in need of treatment may be definitively diagnosed by liver biopsy.
• a liver is considered to be steatotic when a biopsy reveals at least 5-10% w/w fatty deposits (in practice, this is value may be determined microscopically as the fraction of lipid-filled hepatocytes). See, e.g., Clark et al., J. Am. Med. Assoc. 289:3000-3004 (2003) and Adams et al., Can. Med. Assoc. J. 172:899-905 (2005).
• a liver with fatty deposits comprising up to 25% w/w may be considered mildly steatotic, and a liver with fatty deposits comprising greater than 25% w/w may be considered severely steatotic.
• Histological findings indicative of NASH include steatosis, hepatocyte ballooning, lobular inflammation, Mallory hyaline bodies, mixed inflammatory infiltrate, pericellular fibrosis, and perisinusoidal fibrosis. Additional information may be found in, e.g., Neuschwander-Tetri et al., Hepatology 37:1202-1219 (2003).
• Efficacy of treatment may also be determined by detection of a reduction in one or more symptoms or clinical manifestations of a disease as well as any of the test described above for diagnosis.
• an inhibitor of a GSL synthesis enzyme such as, e.g., a compound of Formula I
• a hepatic enzyme e.g., alanine aminotransferase, aspartate aminotransferase, ⁇ -glutamyltransf erase, or alkaline phosphatase
• serum levels of a hepatic enzyme e.g., alanine aminotransferase, aspartate aminotransferase, ⁇ -glutamyltransf erase, or alkaline phosphatase
• a hepatic enzyme e.g., alanine aminotransferase, aspartate aminotransferase, ⁇ -glutamyltransf erase, or alkaline phosphatase
• a hepatic enzyme e.g., alanine aminotransferase, aspartate aminotransferase, ⁇ -glutamyltransf erase, or alkaline phosphatase
• an inhibitor of a GSL synthesis enzyme such as, e.g., a compound of Formula I
• a subject may reduce serum levels of a disease marker (such as, e.g., laminin, hyaluronan, type IV collagen, or immunoglobulin A) at least 10%, such as, e.g., at least 15, 20, 30, 40, 50, 60, 62, 64, 66, 68, or 70%, as compared to pre-treatment control.
• a disease marker such as, e.g., laminin, hyaluronan, type IV collagen, or immunoglobulin A
• Administration of an inhibitor of a GSL synthesis enzyme, such as, e.g., a compound of Formula I, to a subject may reduce, e.g., hyperlipidemia, hypertriglyceridemia, or insulin resistance at least 10%, such as, e.g., at least 15, 20, 30, 40, 50, 60, 62, 64, 66, 68, or 70%.
• an inhibitor of a GSL synthesis enzyme such as, e.g., a compound of Formula I
• a hepatic disorder associated with lipid deposition such as, e.g., cholestasis, fat cysts, fibrosis, granular iron, hepatocellular ballooning, increased numbers of eosinophils, inflammation, lobular disarray, lobular inflammation, macrovesicular steatosis, Mallory bodies, megamitochondria, necrosis, periodic acid-Schiff stained globules, portal inflammation, microvesicular steatosis, or steatosis, as determined by sequential liver biopsies.
• a hepatic disorder associated with lipid deposition such as, e.g., cholestasis, fat cysts, fibrosis, granular iron, hepatocellular ballooning, increased numbers of eosinophils, inflammation, lobular disarray, lobular
• the fraction of hepatocytes having pathogenic lipid deposits and/or the over-all amount of liver fat may be reduced by, e.g., at least 15, 20, 30, 40, 50, 60, 62, 64, 66, 68, or 70%, as compared to pre-treatment control.
• compositions for use in the methods of the invention comprise an inhibitor of GSL synthesis, which may, in certain embodiments, be an inhibitor of GM3 synthesis (such as, e.g., a compound of Formula I) and a pharmaceutically acceptable carrier (excipient).
• an inhibitor of GSL synthesis such as, e.g., a compound of Formula I
• a pharmaceutically acceptable carrier excipient
• suitable pharmaceutical carriers are described in, e.g., Martin, 1990, Remington's Pharmaceutical Sciences, 17th ed. (Mack Pub. Co., Easton, PA).
• Suitable excipients include starch, glucose, lactose, sucrose, gelatin, malt, rice, flour, chalk, silica gel, sodium stearate, glycerol monostearate, talc, sodium chloride, dried skim milk, glycerol, propylene, glycol, water, ethanol, and the like.
• the compositions of the invention may also contain pH buffering reagents and wetting or emulsifying agents.
• the compositions may further contain other active compounds providing supplemental, additional, or enhanced therapeutic functions.
• the pharmaceutical compositions may also be included in a container, pack, or dispenser together with instructions for administration.
• Suitable pharmaceutically acceptable salts of the compounds of the invention may also be included in the pharmaceutical compositions.
• salts include salts of inorganic acids (such as, e.g., hydrochloric, hydrobromic, phosphoric, metaphosphoric, nitric, and sulfuric acids) and of organic acids (such as, e.g., acetic, benzenesulfonic, benzoic, citric, ethanesulfonic, fumaric, gluconic, glycolic, isethionic, lactic, lactobionic, maleic, malic, methanesulfonic, succinic, p-toluenesulfonic, and tartaric acids).
• inorganic acids such as, e.g., hydrochloric, hydrobromic, phosphoric, metaphosphoric, nitric, and sulfuric acids
• organic acids such as, e.g., acetic, benzenesulfonic, benzoic, citric, ethan
• Suitable pharmaceutically acceptable basic salts include ammonium salts, alkali metal salts (such as, e.g., sodium and potassium salts) and alkaline earth metal salts (such as, e.g., magnesium and calcium salts).
• alkali metal salts such as, e.g., sodium and potassium salts
• alkaline earth metal salts such as, e.g., magnesium and calcium salts.
• tartrate salts of the compounds of the invention may be included in the pharmaceutical compositions.
• the compounds of the invention may be present as a hydrate or hemihydrate (of the compound or of its salt).
• compositions can formulated in solid (e.g., powder, tablets), liquid (e.g., aqueous or nonaqueous solutions, dispersions, suspensions or emulsions) or other forms.
• aqueous and nonaqueous carriers, diluents, solvents or vehicles include water (e.g., pyrogen-free water), ethanol, polyols (such as glycerol, propylene glycol, polyethylene glycol, and the like), and suitable mixtures thereof, vegetable oils (such as olive oil), and injectable organic esters such as ethyl oleate.
• water e.g., pyrogen-free water
• polyols such as glycerol, propylene glycol, polyethylene glycol, and the like
• vegetable oils such as olive oil
• injectable organic esters such as ethyl oleate.
• Proper fluidity can be maintained, for example, by the use of coating materials such as lecithin, by the maintenance of the required particle size in the case of dispersions, and by the use of surfactants.
• These compositions may also contain adjuvants, antibacterial and antifungal agents, flavoring agents, biodegradable polymers, etc
• compositions of this invention can be administered to mammals (e.g., humans, rodents, etc.) in any suitable way including, e.g., orally, parenterally, intracisternally, intraperitoneal ⁇ , topically, etc.
• the parenteral administration includes intravenous, intramuscular, intraperitoneal, intrasternal, subcutaneous and intraarticular injection/infusion.
• the inhibitory compounds may also be administered as prodrugs that are metabolized into active compound upon administration.
• the dose of a GSL synthesis inhibitor will vary depending on the subject and upon the particular route of administration used. Dosages may range from 0.1 to 500 mg/kg body weight per day. In one embodiment, the dosing range is 1 -20 mg/kg/day.
• the GSL inhibitor may be administered continuously or at specific timed intervals.
• the GSL inhibitor may be administered 1 , 2, 3, or 4 times per day, such as, e.g., a daily or twice-daily formulation.
• Commercially available assays may be employed to determine optimal dose ranges and/or schedules for administration.
• Assays for measuring blood glucose levels are commercially available (e.g., OneTouch®Ultra®, Lifescan, Inc., Milpitas, CA). Kits to measure human insulin levels are also commercially available (Linco Research, Inc., St. Charles, MO).
• Effective doses may be extrapolated from dose-response curves obtained from animal models.
• suitable animal models include (1) genetic models such as, e.g., the ob/ob mouse, fa/fa (Zucker) rat, or db/db mouse; (2) ovemutrition models, in which animals are fed , e.g., a high sucrose/fructose diet or a high fat diet; (3) the methionine-choline diet deficiency model, which develops steatosis and in, some strains, fibrosis; and (4) transgenic models, such as mice that overexpress the transcription factor SREBP-1 that governs lipid synthesis.
• animal models for fatty liver disease is described in the Examples infra.
• Other animal models are known in the art and are described in , e.g., Koteish et al., Semin. Liver Dis. 21 :89-104 (2001); Masuzaki et al., Science 294:2166-2170 (2001); Lu et al., Proc. Natl. Acad. ScL U.S.A. 98:5560-5565 (2001); Paterson et al., Proc. Natl. Acad. Sci. U.S.A.
• Farrell "Animal models of steatosis" in Fatty Liver Disease: NASH and Related Disorders, Farrell et al., eds. Blackwell Publishing Ltd., Maiden, MA, 2005; Kirsch et al., J. Gastroenter. Hepatol. 18:1272-1282 (2003); Sahai et al., Am. J. Physiol. Gastrointest. Liver Physiol. 287:G1035-1043 (2004); and Lieber et al., Am. J. CHn. Nutr. 79:502-509 (2004).
• Therapeutically effective dosages achieved in one animal model can be converted for use in another animal, including humans, using conversion factors known in the art (see, e.g., Freireich et al., Cancer Chemother. Reports 50:219-244 (1996), Schein et al., CHn. Pharmacol. Ther. 11 :3-40 (1970), and Table 2 below for equivalent surface area dosage factors).
• the invention also contemplates combination therapies for treating liver conditions associated with hepatic lipid deposits.
• the combination therapy may comprise any of the compounds described herein and at least one other compound suitable for treating a liver condition associated with hepatic lipid deposits, or an underlying condition, such as, e.g., diabetes, metabolic syndrome, or alcoholism.
• a GSL synthesis enzyme inhibitor such as, e.g., a compound of Formula I
• a GSL synthesis enzyme inhibitor may be administered in combination with one or more insulin-sensitizing agents, such as, e.g., biguanides, such as, e.g., metformin (Glucophage®; Bristol-Myers Squibb Company; Princeton, NJ); thiazolidinediones such as, e.g., pioglitazone (Actosr®; Takeda Pharmaceutical Company Ltd., Lincolnshire, IL), rosiglitazone (Avandia®; GlaxoSmithKline, Upper Merrian, PA); and leptin.
• biguanides such as, e.g., metformin (Glucophage®; Bristol-Myers Squibb Company; Princeton, NJ
• thiazolidinediones such as, e.g., pioglitazone (Actosr®; Takeda Pharmaceutical Company Ltd
• a GSL synthesis inhibitor may be administered in combination with one or more other examples of compounds used to treat type Il diabetes including, but not limited to, ⁇ -glucosidase inhibitors such as miglitol (Glyset®; Pharmacia, New York, NY); insulin (Novolin®, Novolog®; Velosulin®, Novo Nordisk A/S); meglitinides such as repaglinide (Prandin®; Novo Nordisk, Princeton, NJ) and nateglinide (Starlix®; Novartis Pharmaceuticals, Cambridge, MA); sulfonylureas such as glyburide (Orinase®, Tolinase®, Micronase®, Glynase®; Pharmacia Corp., New York, NY) (Diab ⁇ ta®, Amaryl®; Aventis, Bridgewater, NJ), and chlorpropamide (Diabinese®, Glucotrol®, Glucotrol XL®; Pfizer, New York, NY); and combination drugs
• a GSL synthesis enzyme inhibitor may be administered in combination with one or more antioxidants, such as, e.g., betaine, histamine, vitamin E, lazaroids (21-aminosteroids), ⁇ -acetylcysteine, or S-adenosyl methionine.
• antioxidants such as, e.g., betaine, histamine, vitamin E, lazaroids (21-aminosteroids), ⁇ -acetylcysteine, or S-adenosyl methionine.
• a GM3 synthesis inhibitor may be administered in combination with one or more lipid-lowering or weight loss agents such as, e.g., gemfibrozil (Lopid®; Parke-Davis, New York, NY), orlistat (Xenical®; Roche Laboratories, Inc., Nutley, NJ), pentoxifylline (Trental®; Aventis, Bridgewater, NJ), ursodeoxycholic acid (ursodiol) (Actigall; Watson Pharma, Inc., Corona, CA), and HMG-CoA reductase inhibitors ("statins”) including, e.g., atorvastatin (Lipitor®; Parke-Davis, New York, NY).
• gemfibrozil Linos®
• orlistat Xenical®; Roche Laboratories, Inc., Nutley, NJ
• pentoxifylline Trental®; Aventis, Bridgewater, NJ
• ursodeoxycholic acid ursodiol
• a GSL synthesis enzyme inhibitor may be administered in combination with one or more cytoprotective agents such as, e.g., taurine, ursodeoxycholic acid.
• a GSL synthesis inhibitor may be administered in combination with one or more compounds used to treat alcoholism such as, e.g., acamprosate (Campral®; Merck KGaA, Darmstadt, Germany); alpha-2 adrenergic agonists such as, e.g., clonidine; anticonvulsants such as, e.g., carbamazepine; barbiturates such as, e.g., phenobarbital, pentobarbital, secobarbital; benzodiazepines, such as, e.g., chlordiazepoxide, diazepam, lorazepam, and oxazepam; beta-adrenergic blockers such as, e.g., propranolol;
• Example 1 Reduced hepatic steatosis in DIO mice treated with Formula Xl
• DIO mice Diet-induced obese mice were first generated by placing C57BL/6 mice on a high-fat (45% of kcal) diet (D12451 , Research Diets, Inc., New Brunswick, NJ) for 8 weeks. Obese mice that had elevated glucose and insulin levels were selected and then treated with Formula Xl by daily oral gavage (125 mg/kg) or with water as a control. After 10 weeks of treatment, the livers were harvested, sectioned, and stained with hematoxylin and eosin. Large vacuoles were visible throughout the parenchyma of the livers from the water control mice (Figs. 2A-2C). These vacuoles contain neutral lipid by Oil Red O staining of the liver sections.
• Example 2 Treatment of DlO mice lowered triglyceride levels in the liver
• DIO mice were generated as described in Example 1 and then treated with Formula Xl by daily oral gavage at a dose of 75 or 125 mg/kg. Mice gavaged with water served as the control. After 16 weeks of treatment the livers were harvested and homogenized. The lipids were extracted with methanol :chloroform (4.3:3 v/v) and CaCk. The extracted lipids were dried and dissolved in dimethylsulfoxide (DMSO). Triglycerides were measured using the Serum Triglyceride Determination kit (Sigma-Aldrich, St. Louis, MO) according to the protocol supplied by the manufacturer. The results (Fig. 3) show a dose-dependent reduction in total triglyceride levels as a result of treatment with Formula Xl, indicating that treatment with Formula Xl is effective in treating hepatic steatosis in the livers of DIO mice.
• DMSO dimethylsulfoxide
• Example 3 Reduced liver weights in DIO mice treated with Formula Xl
• DIO mice were generated as described in Example 1. Mice were maintained on the high-fat diet for an additional 23 weeks (total time on diet 31 weeks). The mice were then treated with Formula Xl by daily oral gavage (125 mg/kg/day). Drug treatment did not significantly affect body weight compared to the placebo (water) treated control group. After 9 and 17 weeks of treatment, groups of animals were sacrificed and the livers dissected and weighed. In the DIO mice, the liver weight to body weight ratio was higher than in lean animals. Treatment with Formula Xl significantly reduced the liver weights, and after 17 weeks of treatment the liver/body weight ratio was comparable to that of the lean group (Fig. 4). This result suggests that drug treatment could reverse and normalize at least one measure of the gross pathology of the liver in the obese mice.
• DIO mice were generated as described in Example 1. Mice were maintained on the high-fat diet for an additional 23 weeks (total time on diet 31 weeks). The mice were then treated with Formula Xl by daily oral gavage (125 mg/kg/day). Blood was collected after 9 weeks of treatment and markers of liver toxicity were analyzed (IDEXX Laboratories, West Sacramento, CA). Lower levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, and gamma-glutamyltransferase (GGT) were found in the drug-treated versus placebo-treated control animals (Figs. 5A-5D). This result indicates that treatment with Formula Xl can decrease markers of liver toxicity present in the obese animals fed a high-fat diet, further indicating that treatment with Formula Xl is effective in treating hepatic steatosis in the livers of DIO mice.
• ALT alanine aminotransferase
• AST aspartate aminotransfera
• Example 5 Reduced hepatic steatosis in DIO mice treated with gluco-4-epoxy-4-C-methyleneglycosyceramide
• DIO mice are first generated by placing C57BL/6 mice on a high-fat (45% of kcal) diet (D12451 , Research Diets, Inc., New Brunswick, NJ) for 8 weeks. Obese mice having elevated glucose and insulin levels are selected and treated with gluco-4-epoxy-4-(_ ⁇ methyleneglycosyceramide by daily oral gavage (125 mg/kg) or with water as a control. After 10 weeks of treatment, the condition of the mice is evaluated. It is expected that the treatment will result in treatment of the FLD in the mice as determined by one or more of the following:
• Example 6 Reduced liver weights in ob/ob mice treated with Formula X
• Example 7 Reduced expression of hepatic genes involved in lipogenesis, gluconeogenesis, inflammation, and fibrosis in ob/ob mice treated with Formula X
• SREBP-Ic sterol regulatory element binding protein 1c
• ACL1 acid citrate lyase 1
• ACC1 acetyl coenzyme A carboxylase 1
• FES fatty acid synthase
• TNF- ⁇ tumor necrosis factor 1 alpha
• G6P glucose 6- phosphatase
• procollagen type 1 procollagen

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